I was shrinking my carbon footprint on the bus from Chicago trying to jot down notes about my thoughts on healthcare when the cold medicine took hold and the twisted facts everywhere began to resemble the screeching of bats. I’ve let the post rest but I’m still stuck in a rut where every time I see Harry and Louise I end up ruminating on Duke and Dr. Gonzo.
“There was every reason to believe I was heading for trouble, that I’d pushed my luck a bit far. I’d abused every rule Vegas lived by-burning locals, abusing the tourists, terrifying the help.
“The only hope now, I felt, was the possibility that we’d gone to such excess, with our gig, that nobody in a position to bring the hammer down on us could possibly believe it. …When you bring an act into this town, you want to bring it in heavy. Don’t waste any time with cheap shucks and misdemeanors. Go straight for the jugular. Get right into felonies.” Hunter S. Thompson,Fear and Loathing in Las Vegas
There are so many past patterns of power, odd partnerships, conflicts of interest and baskets of money floating around that it’s tough to tear through the rhetoric and figure out where to stand. There are a few sources that I’ve been following that seem to cut through the rhetoric rather well, mostly technical in the healthcare and economics sphere. Their arguments seldom reach the fevered pitch necessary to break into the popular media although Baseline Scenario’s recent headline tries: “You Do Not Have Health Insurance” is a great summation of the current system’s flaws. If you’re not paranoid now, read the article and it will help you along.
Paranoia reigns. Discussions are difficult. Fear of losing, fear of lacking, fear of change.
Innovate or Die
A business mantra that takes on a more sinister meaning in the healthcare debate. But true nonetheless. There is writing on the wall. The risk that healthcare will be out of your reach when you need it most is increasing and there are no guarantees that the current round of regulatory mayhem in Washington will correct course. Insurance companies like the package. Can that be good? How to judge?
I find that when fear drives change, decision-making tends to favor knowns over unknowns. Slight changes-of-course rather than liftoffs.
I hate making decisions based on fear.
Arguments fall to the level of school yard brawls, he said she said insults. Contradictory facts thrown at every issue designed to muddy not clarify. There is a lot of money in stay the course. There is a lot of power in change. The only losers in this battle seem to be individuals whose voices are muted by the roar of past patterns of power and future wanna be’s. Where can I find firm ground to add my measly little vote into the equation? How can I manage my fear to better make decisions? I’ve decided first to limit what I’m willing to be afraid of.
These are a few of my favorite fears…
- Loss of Access. Simple. Straightforward. Currently we are on a path where healthcare is rationed by pocketbook and employer. If you have the right job and the right income you can afford the best treatments in the world. Odds are increasing that I will not be among this lucky group. (As they are for most of us.) Which brings us to my second fear:
- Limits To Where I Work and What I Do. Getting caught seriously, chronically ill away from a major employer has downsides. Rescissions and price increases try to drive you from the system and cause serious problems for your employer and co-workers. (Click the rescissions link to see how a .5% rescission rate claimed in congressional testimony can magically turn into 50-50 odds of loosing your insurance if you file a massive claim.) Being forced to make a job decision based on availability of healthcare has implications for the economy and democracy as a whole. Which leads to fear #3.
- Talent Drain. America is driven by small business. It is where most jobs are and possibly where most innovation starts. It is where the rogue operatives who can’t stand corporate bureaucracy run to create beautiful things. Small business is at a competitive disadvantage in providing health insurance to their employees. If a single employee becomes chronically ill, price increases designed to force the company to drop insurance for all employees create a terrible conflict. Get the sick individual to leave or lose health insurance for all. This results in a permanent disadvantage for small business that is getting worse with time. Which brings me to my final and biggest fear.
- Innovation Stagnation. The US has driven most healthcare innovation over the past century. Sometimes misdirected, usually expensive and often oversold as it is, it still has provided vast benefits for the world. Locking in some variant of the current system or some variant of a European single payer system could very well end rapid innovation as we know it today. Then again the right incentives could light a fire under the next wave of improvements from a different angle.
The loathing part.
We’re on a political path that involves much screaming and very little doing. We have corporations demanding to be released from regulations at the same time they craft regulations to hamper their competitors. Hypocrisy is a word I try to avoid, but it feels right here. The arguments are about power and control on both sides with progress by either side always seen as a threat to the future power base of the other. Why would we accept such a thing? Are the errors so huge that we simply can’t believe reasonable human beings are capable of making them?
Where is the radical transformation of information processes that is happening elsewhere in the economy? Where is the democratization of information going on elsewhere in the tech world? Maybe the truly radical approach to healthcare reform is not through centralization, but in radical individualization.
How can we raise the bar on this debate? Three little steps.
- Decide what truly concerns you and frame answers to that concern. You need a defense against scattershot arguments. If you have a solid hypothesis then you can evaluate whether an argument presented even merits evaluation given your concern.
- Remember that other’s fears may be different than your own. Understand the framework of their concerns and how their points fit their framework.
- Merge and Purge. See where your hypothesis and concerns overlap. See if you can at least agree on a problem. At this point purge arguments that are sideways – seemingly relevant but framed in a way to create conflict rather than find solution. (For example, the difference between arguing U.S. average outcomes are terrible compared to other countries vs the US having the most sophisticated medicine around. The two ‘facts’ are not necessarily contradictory – they are addressing different concerns however.)
Once again a post with more questions than answers. Must be the meds. Fear and Loathing in Las Vegas has different appeal to different folks. I’ve always seen it as a primal scream in the Las Vegas wilderness when reality, ideals and momentum simply refused to mesh up in a comfortable way. Sounds a bit like healthcare, don’t you think?